心房颤动导管射频消融静脉电隔离前后的抗凝治疗

Anticoagulation Therapy in Patients With Paroxysmal Atrial Fibrillation Before and After the Pulmonary Vein Isolation.

探讨心房颤动 (简称房颤 )导管射频消融静脉电隔离前后的抗凝治疗 ,2 0 0 1年 8月到 2 0 0 4年 4月连续收治行射频消融治疗的阵发性房颤患者 15 6例 ,男 118例 ,女 38例 ,年龄 5 4± 10岁。术前行经食管心脏超声和 /或螺旋CT心脏成像检查排除心房内血栓 ;有高血压、糖尿病、一过性脑缺血发作 (TIA)或脑卒中史、或年龄大于 6 5岁的房颤患者术前华法林抗凝治疗 1个月 ;术后华法林抗凝治疗 1～ 3个月。结果 :前 4 0例患者在手术前后未按上述方法进行常规检查和规范抗凝治疗 ,术中脑栓塞引起失语和左上肢肌力下降 1例 ,术中和术后第三天TIA各 1例。 3例均伴有高血压 ,其中 1名合并有糖尿病。以后的 116例患者术前均行食管超声和 /或螺旋CT检查 ,手术前后及术中进行正规抗凝治疗 ,未再发生血栓栓塞事件 (3/ 4 0vs 0 / 116 ,P =0 .0 16 )。结论 :房颤患者在导管射频消融静脉电隔离手术前常规行经食管超声和 /或螺旋CT检查排除心房血栓 ,并在手术前后及术中进行规范抗凝治疗可有效预防手术相关血栓栓塞并发症。

The efficacy of anticoagulation therapy in patients with paroxysmal atrial fibrillation (PAF) who underwent pulmonary vein isolation were evaluated. Segmental pulmonary vein isolation was performed in 156 consecutive patients (118 men; mean age 54±10 years) with symptomatic PAF. In the first 40 patients (Group 1), transesophageal echocardiography (TEE) or spiral CT cardiac examination was not performed before ablation and anticoagulation using warfarin was not administrated either before or after the procedure. In the remaining 116 patients (Group 2), routine TEE and/or spiral CT examination was performed before ablation and warfarin was given for 1 month in patients with one of the following risk factors:hypertension, diabetes, a history of transient ischemic attack or stroke, and >65 years old. Anticoagulant was also administrated in all the 116 patients after ablation for 1 to 3 months. Results:One patient experienced ischemic stroke and 2 had transient ischemic attack during or after the procedure in Group 1 patients. In contrast, thromboembolic event was not observed in any of the Group 2 patients (3/40 vs 0/116, P =0.016). Conclusions:Thromboembolic event related to the pulmonary vein isolation procedure in patients with PAF could be prevented by routine TEE and/or spiral CT cardiac examination and anticoagulation using warfarin.